Is there a deformity at the base of the 5th metatarsal?

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Last updated: December 16, 2025View editorial policy

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Yes, there is a recognized deformity at the base of the 5th metatarsal called bunionette deformity (tailor's bunion)

Bunionette deformity is a forefoot protuberance located laterally, dorsolaterally, or plantarlaterally along the fifth metatarsal head and base, resulting from a multifactorial anatomic interplay between fifth metatarsal bony morphology and forefoot soft-tissue imbalance. 1

Anatomic Characteristics of the Deformity

  • The deformity involves metatarsus quintus valgus (outward deviation of the fifth metatarsal) combined with varus deformity of the fifth toe with subluxation of the metatarsophalangeal joint 2

  • The bony prominence can manifest in different locations along the fifth metatarsal, with classification systems (such as Shimobayashi) recognizing Types I through V based on the specific anatomic pattern 3

  • Friction between the bony prominence, soft tissue, and constrictive footwear results in keratosis, inflammation, pain, and potential ulceration 1

Clinical Significance

  • This is a common foot disorder that warrants proper evaluation when symptomatic 1, 4

  • The deformity can be assessed radiographically using the fourth-to-fifth intermetatarsal angle, which averages around 12 degrees in symptomatic patients before correction 3

  • In diabetic patients with neuropathy and foot deformities, special attention must be paid to offloading areas overlying bony deformities to prevent ulceration 5

Diagnostic Approach

  • Standard three-view radiographs (anteroposterior, lateral, and mortise) are necessary to properly evaluate the bony anatomy and confirm the deformity 6, 7

  • For non-painful swelling at the base of the fifth metatarsal, MRI is the preferred advanced imaging modality if radiographs are negative, as it can detect occult fractures, accessory ossicles, bone marrow edema, and soft tissue pathology 7

  • Accessory ossicles occur in 4% of asymptomatic subjects and must be differentiated from true deformity through clinical correlation 7

References

Research

Management of Bunionette Deformity.

The Journal of the American Academy of Orthopaedic Surgeons, 2018

Research

Minimally invasive bunionette correction.

Operative Orthopadie und Traumatologie, 2018

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Management of Fifth Metatarsal Fractures

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Guideline

Diagnostic Approach for Non-Painful Swelling at the Base of the 5th Metatarsal

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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